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Unit 1: Upper Limb

Objectives:
●  Name the main bony structures of the upper extremity as discussed in lectures
●  Name the main origins and insertions of the muscles of the upper extremity as discussed in lectures
●  Describe the basic functions of these muscles
●  Describe the nerve supply of the muscles of the upper extremity discussed in lectures
●  Describe the general blood supply of the muscles of the upper extremity as discussed in lectures
●  Demonstrate locations for palpation of the pulse in major arteries in the upper extremity
●  Describe the venous system of the upper extremity
●  Demonstrate the locations for drawing blood in the upper extremity
●  Demonstrate the pathways of major nerves of the upper extremity along with their cutaneous distributions.
●  Describe the dermatomes of the upper extremity.

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Introduction to Anatomy

Anatomical Planes
●  Coronal plane→ oriented vertically and
divide the body into anterior and posterior
parts

●  Sagittal plane→ oriented vertically and

divide body into left and right parts that are
not necessarily equal
○  Median sagittal plane→ divides body
into equal left and right parts

●  Transverse (horizontal or axial)

planes→ divide body into superior and
inferior parts

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Skeletal System

●  Axial skeleton→ skull, vertebral

column, ribs and sternum

●  Appendicular skeleton→ bones

of upper and lower extremities

Bone
●  Calcified, living connective tissue
that forms majority of skeleton

●  Functions:
○  Supportive structures for body
○  Protect vital organs
○  Reservoirs of calcium and
phosphorus
○  Levers on which muscles act to
produce movement
○  Site of blood-production

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Bone-Types
●  Compact bone→ dense bone
that forms the outer shell of all
bones and surrounds spongy
bone

●  Spongy bone→ consists of

spicules of bone enclosing
cavities containing blood-forming
cells (marrow)

Bone-Classification
●  Long bones→ tubular (i.e humerus
and femur)

●  Short bones→ cuboidal (i.e bones of

wrist and ankle)

●  Flat bones→ consist of two compact

bone plates separated by spongy
bone (i.e skull)

●  Irregular bones→ those with

various shapes (i.e bones of the face)

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Cartilage
●  Avascular form of
connective tissue (nourished
by diffusion)
●  Functions:
○  Support soft tissues
○  Provide a smooth gliding
surface for bone
articulations at joints
○  Enable the development
and growth of long
bones

Cartilage-Types
●  Hyaline→ most common;matrix contains a
moderate amount of collagen fibers. (i.e in
articular surfaces of bones)

●  Fibrocartilage→ matrix contains a limited

number of cells and ground substance
amidst a substantial amount of collagen
fibers. (i.e intervertebral discs, pubic
symphysis)

●  Elastic→ matrix contains collagen fibers

and elastic fibers. (i.e external ear, nose)

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Skin-Functions
●  Mechanical and permeability barrier
●  Sensory and thermoregulatory organ
●  Can also initiate primary immune responses

Skin-Structure

●  Epidermis→ stratified
squamous epithelium which
is avascular and varies in
thickness

●  Dermis→ dense bed of

vascular connective tissue

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Fascia
●  Connective tissue containing varying
amounts of fat

●  Functions:
○  Separate, support and
interconnect organs and structures
○  Enables movement of one
structure relative to another
○  Allows the transit of vessels and
nerves

Fascia-Superficial Types
●  Lies just deep to and is attached to the
dermis of the skin
●  Composed of loose CT containing large
amounts of fat
●  Thickness varies depending on location in
body
●  Functions:
○  Allows movement of skin over deeper
areas of body
○  Act as conduit for vessels and nerves
○  Serves as an energy (fat) reservoir

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Fascia-Deep Fascia
●  Dense organized CT
●  Outer layer is attached to deep surface of
superficial fascia
●  Forms a thin fibrous covering over deeper regions
of body
●  Intermuscular septa which compartmentalizes
groups of muscles with similar functions and
innervations
●  Retinacula→ thick fascia near joints that holds
tendons in place
●  Extraperitoneal or Endothoracic fascia→
layer that separates the membrane lining the
abdominal cavity/thorax from fascia covering the
deep surfaces of the muscles

Skeletal Muscle
●  Majority of muscle tissue in body
●  Structure: consists of parallel bundles of
long multinucleated fibers with transverse
fibers
●  Innervation: somatic and branchial motor
nerves
●  Functions:
○  Move bones and other structures
○  Provide support
○  Gives form to the body
●  Named on:
○  Attachments
○  Function
○  Position
○  Fiber orientation

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Module 1: Upper Limb Osteology

Vertebra

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Vertebra
Spinous process Transverse process

Upper Limb-Bones

●  Shoulder (pectoral) girdle→

clavicle + scapula
●  Humerus
●  Radius and ulna
●  Carpal bones
●  Metacarpal bones
●  Phalanges

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Upper Limb-Regions
●  Shoulder→ pectoral girdle to
glenohumeral (shoulder) joint
○  Bones: clavicle and scapula
●  Arm (brachium)→ glenohumeral joint to
elbow joint.
○  Bones: humerus
●  Forearm (antebrachium)→ elbow to
wrist joint
○  Bones: radius and ulna
●  Wrist→ wrist joint
○  Bones: carpal and metacarpal bones
●  Hand→ wrist joint to fingers
○  Bones: phalanges

Upper Limb-Areas of Transition

●  Axilla→ irregular shaped pyramidal area
formed by muscles and bones of shoulder and
lateral surface of thoracic wall. All major
structures of neck and arm pass through here.

●  Cubital fossa→ triangular shaped depression

formed by muscles anterior to elbow joint.
Brachial artery and median nerve pass
through here.

●  Carpal tunnel→ gateway of palm to hand.

Median nerve and long flexor tendons pass
through here.

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Upper Limb-Shoulder Girdle

Clavicle
●  Only bony attachment between the
trunk and the upper limb and most
common fractured in body

●  Acromial (lateral) end → flat which

attaches to manubrium of sternum

●  Costal tuberosity→ attaches to first

costal cartilage

●  Sternal (medial) end→ small val

facet for articulation with the
acromion of the scapula

●  Conoid tubercle→ attachment of

coracoclavicular ligament

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Clavicle-Sternal End

Clavicle-Acromial End

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Scapula
●  Large, flat triangular bone
with:
●  3 angles: lateral, superior
and inferior
●  3 borders: superior, lateral
and medial
●  2 surfaces: anterior
(costal) and posterior
●  3 processes: acromion,
spine and coracoid process

Scapula-Anterior vs Posterior Surface

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Scapula-Anterior vs Posterior Surface

Scapula-Medial Border

●  Thin and sharp

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Scapula-Lateral Border
●  Strong and thick for muscle
attachment

Scapula-Superior Border
●  Thin and sharp

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Scapula-Superior Angle

Scapula-Inferior Angle

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Scapula-Lateral Angle

Scapula-Coracoid Process

Anterior view Posterior view

●  Positioned directly
inferior to the
lateral part of the
clavicle

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Scapula-Acromion

Anterior view Posterior view

●  Articulates with the

clavicle at the
glenohumeral joint

Scapula-Spine
●  Divides the posterior surface of the scapula into
supraspinous fossa and infraspinous fossa

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Scapula-Suprascapular Notch
●  Attachment site for the spine to the posterior surface of
the scapula

Scapula-Fossae

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Scapula-Supraspinous vs Infraspinous fossa

Scapula-Supraspinous fossa

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Scapula-Infraspinous fossa

Scapula-Subscapular fossa

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Scapula-Subscapular fossa

Scapula-Glenoid Fossa

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Scapula-Supraglenoid tubercle

●  Site for
attachment for
the long head
of the biceps
brachii muscle

Scapula-Infraglenoid tubercle

●  Site for
attachment for
the long head
of the triceps
brachii muscle

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Humerus

●  Long bone
of arm

Humerus-

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Humerus- Head of Humerus

Humerus- Head and Shaft Shaft (body)

●  Head→ articulates
with glenoid cavity

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Humerus- Anatomical vs Surgical Neck

Anatomical neck Surgical neck

●  Surgical
neck→ site
where humerus
commonly
fractures
(weaker region)

Humerus- Greater tubercle

●  Site of attachment for:
suprasinatus, infraspinatus and
teres minor (3 of 4 rotator cuff
muscles)

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Humerus- Lesser tubercle

●  Site of attachment for:
subscapularis muscle (1
of 4 rotator cuff
muscles)

Humerus- Intertubercular sulcus (bicipital groove)

●  Separates greater and lesser
tubercles
●  Tendon of the long head of the
biceps brachii passes through here

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Humerus- Deltoid tuberosity

●  Site where deltoid muscle inserts into humerus

Humerus- Radial groove

●  Radial nerve and

profunda brachial artery
lie here

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Humerus- Medial epicondyle

●  Site of attachment for
muscles of the anterior
compartment of the
forearm.
●  Ulnar nerve passes
posteriorly to it (funny
bone)

Humerus- Lateral Epicondyle

●  Site of attachment for
muscles of the
posterior compartment
of the forearm.

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Humerus- Distal end/Anterior view

Humerus- Anterior View

●  Medial supraepicondylar
ridge (left)→ less
pronounced
●  Lateral supraepicondylar
ridge (right) → more
pronounced, attachment
site for muscles found in
the posterior compartment
of the forearm

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Humerus- Capitulum

●  Covered with
cartilage
●  Articulates with the
radius

Humerus- Trochlea

●  Covered with
cartilage
●  Articulates with the
ulna

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Humerus- Radial fossa

●  Radial head articulates here during
elbow flexion

Humerus- Coronoid fossa

●  Articulates with coronoid
process of ulna during elbow
flexion

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Humerus- Olecranon fossa

●  Articulates with
olecranon process
of ulna during elbow
extension

Humerus- Radius
& Ulna

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Elbow Joint

Elbow Joint-Supination vs Pronation

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Elbow Joint-Supination vs Pronation

Radius
●  Anterior border→ medial side of the bone as a
continuation of the radial tuberosity
●  Posterior border→ distinct only in the middle of
the bone
●  Interosseous border→ sharp and attachment
site for the interosseous membrane, which links
the radius to ulna

●  Anterior surface→ smooth and unremarkable

●  Posterior surface→ characterized by dorsal
tubercle
●  Lateral surface→ diamond shaped and extends
distally as radial styloid process

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Forearm- Radius & Ulna

●  Divided into anterior and

posterior compartments:
○  Lateral intermuscular
septum
○  Interosseous
membrane
○  Attachment of deep
fascia along posterior
border of ulna

Radius-Head
●  Articulates with
capitulum of
humerus

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Radius-Neck

Radius-Tuberosity
●  Site of
attachment for
biceps brachii
tendon

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Radius-Styloid process

Radius- Interosseous
border

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Radius-Dorsal (Lister’s) tubercle

Ulna
●  Anterior border→ smooth and rounded
●  Posterior border→ sharp and palpitabe along its
edge
●  Interosseous border→ sharp and attachment
site for the interosseous membrane, which links
the radius to ulna

●  Anterior surface→ smooth except distally where

the pronatus quadratus muscle attaches
●  Medial surface→ smooth and unremarkable
●  Posterior surface→ marked by lines which
separate different regions of muscle attachments
to bone

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Ulna-Head

Ulna-Olecranon process
●  Articulates with trochlea of
humerus
●  Articulates with olecranon
process of humerus during
elbow extension

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Ulnar-Radial Notch

●  Articulates with
head of radius

Ulna-Trochlear Notch

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Ulna-Coronoid process

●  Articulates with
coronoid of humerus
during elbow flexion

Ulna-Tuberosity
●  Attachment site
for brachialis
muscle

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Ulna-Styloid process

Distal radio-ulnar joint

●  Where the radius articulates with

the ulna
●  Where the radius articulates with
the scaphoid and lunate carpal
bones
●  Where the distal ulna articulates
with fibrocartilage which then
articulates with the triquetrum
carpal bone

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Hand and Wrist

Carpal bone-Trapezium

●  Articulates with
metacarpal of
thumb

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Carpal bones-Trapezoid

●  Four sided
cuboidal bone

Carpal bone-Capitate

●  Articulates with
base of
metacarpal III

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Carpal bone-Hamate

●  Has a prominent
hook

Carpal bone-Scaphoid

●  Boat shaped bone

●  Where radius
articulates

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Carpal bone-Lunate

●  Crescent shaped
●  Where radius
articulates

Carpal bone-Triquetrum

●  Three-sided bone
●  Where ulna
articulates

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Carpal bone-Pisiform

●  Pea shaped seasamoid

bone
●  Articulates with
triquetrom

Carpal bones

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Metacarpals-First
●  Metacarpal I→ thumb

Metacarpals-Second
●  Metacarpal II→ index finger

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Metacarpals-Third
●  Metacarpal III→ middle finger

Metacarpals-Fourth
●  Metacarpal IV→ ring finger

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Metacarpals-Fifth
●  Metacarpal V→ index (pinky) finger

Phalanges-

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Phalanges- Thumb Proximal vs Distal

Proximal Distal
phalanx phalanx

Phalanges-Proximal

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Phalanges-Middle

Phalanges-Distal

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●  Styloid process of radius

Terms to Know Humerus:
●  Head
●  Interosseous border
●  Dorsal tubercle
●  Anatomical neck
Vertebra: Ulna:
●  Surgical neck
●  Spinous process ●  Olecranon process
●  Greater tubercle
●  Transverse process ●  Coronoid process
●  Lesser tubercle
●  Trochlear notch
●  Intertubercular sulcus (also
Clavicle: ●  Radial notch
called bicipital groove)
●  Acromial end ●  Ulnar tuberosity
●  Deltoid tuberosity
●  Sternal end ●  Styloid process of ulna
●  Radial groove
●  Interosseous border
●  Medial and lateral epicondyles
Scapula: 8 carpal bones:
●  Medial and lateral
●  Acromion process ●  Scaphoid
supracondylar ridges
●  Coracoid Process ●  Lunate
●  Capitulum
●  Glenoid cavity ●  Triquetrum
●  Trochlea
●  Neck ●  Pisiform
●  Radial fossa
●  3 Angles and 3 borders ●  Trapezium
●  Coronoid fossa
●  Supra and Infraglenoid ●  Trapezoid
●  Olecranon fossa.
tubercles ●  Capitate
●  Suprascapular notch ●  Hamate
Radius:
●  Subscapular fossa Bone of the hand:
●  Head
●  Spine ●  Metacarpal
●  Neck
●  Supraspinous fossa ●  Proximal and distal phalanges
●  Tuberosity
●  Infraspinous fossa

Questions
1.  The shoulder girdle is formed by the following pair of bones:
a.  scaphoid and lunate
b.  radius and ulna
c.  ulna and humerus
d.  humerus and scapula
e.  scapula and clavicle
2.  In the anatomical position, the index finger is found in which of the following
positions
a.  Lateral to the middle finger
b.  Medial to the middle finger
c.  Lateral to the thumb
d.  Medial to the little finger
3.  The radial fossa is found on which of the following bone:
a.  Scapula
b.  Humerus Answers:
c.  Radius 1.  e
d.  Ulna 2.  a
3.  b

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